In the medical world, an increasing number and type of surgeries are being performed using minimally invasive techniques. Typically, these procedures involve making one or more relatively small incisions in the patient in proximity to the surgical target. A cannula or other type of surgical port (hereinafter referred to generally as a “surgical port”) is inserted into the patient through the incision to form a conduit through which the surgeon can access the surgical site. The surgeon then performs the entire surgery from the exterior of the patient's body by manipulating surgical devices and instruments through the surgical port.
Multiple different surgical instruments, such as needle holders, graspers, scissors, clip appliers etc., are often used during the course of a surgical procedure. These procedures also frequently require surgical sutures, clips, anchors or the like to mend or repair tissue or organs. For the purposes of this disclosure, the term “surgical elements” is used to generally refer to all devices, instruments or other objects that are used within a patient's body during surgery. Because only small incisions are made in the body for minimally invasive surgery, all surgical elements must be introduced into the surgical site through the surgical port as needed. For example, if the procedure requires removal of tissue and subsequent mending of the injured area, a surgeon may first insert through the surgical port a surgical tool having a cutting tip to perform the necessary cutting. This tool is subsequently removed from the patient and may be exchanged for another tool having a grasping element at the end that can hold a needle and perform necessary suturing. This tool, along with the suture and needle, must then be inserted into the surgical site through the surgical port. If another suture is required, the tool must be removed through the surgical port, and reintroduced into the surgical site with another suture. Thus, every time a new instrument or device is needed at the surgical site, it must be separately introduced through the surgical port.
Removal and reintroduction of surgical instruments and devices into the surgical site is time consuming. Further, inserting a surgical tool that is grasping an element such as a suture is difficult, as the diameter of the surgical port is relatively small, typically in the order of 5-25 mm. The needle, on the other hand, may be curved and can have a length and width of up to 20 mm and 12 mm respectively. Often, the surgeon must grab the needle in one manner to be able to pass it through the surgical port, then, once inside the patient, must re-grasp it in another orientation to perform the suturing. To do this, it is often necessary to manipulate the extremely sharp needle directly on the surface of the tissues until it is in the correct orientation to be grasped. As indicated, this entire process of removing the tool and reintroducing another suture and needle must be performed when another suture is needed.
For each suture, once the suturing has been completed, the needle must be removed from inside the patient. Damage to the cannula caused by the sharp needle is a problem that is frequently encountered. In particular, the airtight seal within the cannula that prevents gas from escaping or entering the surgical site can easily be damaged by the sharp needles. In sum, the introduction of surgical instruments and devices into the surgical site is a difficult and time consuming aspect of minimally invasive surgery.
These issues are compounded when robotics are used in conjunction with minimally invasive surgery. In robotic surgery, robotic arms perform the actual surgery, with the robotic arms being remotely controlled by the surgeon via a computer or the like. Removal of the robotic arms from the surgical site via a surgical port is undesirable, as the surgeon's viewpoint provided by a video camera is internal surgical space. Complete withdrawal of the instrument requires secondary team members to reposition the instrument back through the surgical port and back into the surgeon's field of view.
Accordingly, it is desirable to achieve a system and method for introducing a plurality of surgical elements into surgical site at one time, particularly in conjunction with performing minimally invasive surgery. It is further desirable to provide a method for performing such surgery utilizing this system and method.